• Giuseppe Catapano, Francesco Giovanni Sgulò, Piedad Elizabeth Acurio Padilla, Pietro Spennato, Giuseppe Di Nuzzo, Vincenzo Boniello, and Matteo de Notaris.
• Department of Neuroscience, "G. Rummo" Hospital, Neurosurgery Operative Unit, Benevento, Italy.
• World Neurosurg. 2018 Aug 1; 116: 105-109.

ObjectiveRecently, the neuronavigation system (NS) has become an essential intraoperative tool for many neurosurgical procedures, allowing for precise lesion localization. It is particularly important to avoid errors during the navigation process. Here we report a novel technique using palatal positioning of the patient tracker to ensure optimal accuracy during magnetic navigation in various neurosurgical procedures.MethodsThis retrospective study included a total of 34 patients treated in our institution between June 2017 and January 2018. The patients were split into 2 groups who underwent surgery under general anesthesia: a microscopic transcranial group and an endoscopic endonasal group. Preoperative and postoperative navigation accuracy was assessed by 2 neurosurgeons.ResultsAfter our surgical planning navigation protocol was applied, both transcranial and endonasal procedures were successfully performed under navigation guidance in all but 1 patient. There were no intraoperative or postoperative complications related to the tracker mounted under the hard palate. In 33 cases a maximal tracking view and optimal navigation accuracy was achieved, for a success rate of 97%.ConclusionsThe positioning of the patient tracker under the hard palate proved safe, accurate, and feasible in 97% of our patients. In our case series, it met the main goal of avoiding device displacement without a sense of invasiveness and postoperative patient discomfort.Copyright © 2018 Elsevier Inc. All rights reserved.

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